目的 探讨以跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用效果。方法 将2020年1月—10月重症医学科收治的100例ARDS患者随机分为对照组和观察组各50例,对照组采用小潮气量辅助控制通气治疗,观察组以跨肺压(transpulmonary pressure,Ptp)为导向选择最佳呼气末正压(positive end-expiratory pressure,PEEP)进行机械通气治疗,观察比较两组患者治疗前和治疗48 h的呼吸动力学指标、血气分析指标,随访28 d病死率。结果 治疗48 h,潮气量、PEEP、肺静态顺应性、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂观察组明显高于对照组(P＜0.05);随访28 d病死率观察组和对照组比较差异无统计学意义(P＞0.05)。结论 以Ptp为导向选择最佳PEEP的机械通气治疗ARDS可以有效改善患者的呼吸动力学指标和血气分析指标,不增加ARDS的病死率,值得临床推广应用。

Objective To investigate the clinical effect of positive end-expiratory pressure(PEEP) ventilation guided by transpulmonary pressure (Ptp) in acute respiratory distress syndrome (ARDS). Methods Between January and October 2020, 100 cases of ARDS treated in intensive care unit were randomly divided into control group and observation group with 50 cases each. Control group used auxiliary control small tidal volume ventilation therapy, and observation group used the best PEEP mechanical ventilation therapy with the guiding of Ptp. The respiratory dynamics index, blood gas analysis results, follow-up of 28d case fatality rate before and 48h after treatment between the two groups were compared. Results After 48h of treatment, tidal volume、PEEP、pulmonary static compliance、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂ of the observation group were all higher than those of the control group (P<0.05). There was no statistically significant difference in mortality between the two groups at 28d follow-up (P＞0.05). Conclusion Mechanical ventilation with the best PEEP guided by Ptp could effectively improve the respiratory dynamic index and blood gas analysis results of patients with ARDS, without increasing the mortality of ARDS, which is worthy of clinical application.

目的 探讨大黄穴位贴联合直肠指力刺激在脑卒中后便秘患者的应用效果。方法 本研究选择2019年1月—2019年12月间我院收治的脑卒中后便秘患者90例,随机分成A组(大黄穴位贴组),B组(直肠指力刺激组),C组(大黄穴位贴联合直肠指力刺激组)三组,每组30例。记录三组患者便秘治疗有效率,采用Wexner便秘评分系统评估三组患者治疗前后的便秘程度并进行自身前后对比。结果 三组干预前后Wexner评分采用自身配对非参数秩和检验,差异有统计学意义(P＜0.05)。三组干预前后差值采用Kruskal-Wallis H检验结果差异有统计学意义(H=26.211,P＜0.05),经过两两对比,差异有统计学意义(P＜0.05)。值得注意的是,干预后C组Wexner评分下降。干预后C组患者的有效率高于其他两组,有效率结果为C组(90%)＞B组(80%)＞A组(53.5%),差异有统计学意义(P＜0.05)。结论 相较于单一应用大黄穴位贴或直肠指力刺激,大黄穴位贴联合直肠指力刺激治疗效果更好,可有效降低便秘发生率,提高病人生活质量。

Objective To explore the effect of rhubarb acupoint application combined with rectal finger force stimulation in patients with constipation after stroke. Methods In this study, 90 patients with post-stroke constipation admitted to our hospital from January 2019 to December 2019 were randomly divided into group A (rhubarb acupoint application group), group B (rectal finger force stimulation group) and group C (rhubarb acupoint application combined with rectal finger force stimulation group), 30 cases in each group. The effective rates of constipation treatment in the three groups were recorded, and the Wexner constipation scoring system was used to evaluate the degree of constipation before and after treatment among three groups. Results The Wexner scores of the three groups before and after treatment were analyzed by self-paired non-parametric rank sum test, and the differences were statistically significant (all P<0.05). The difference among the three groups before and after treatment using Kruskal-Wallis H test was statistically significant (H=26.211, P<0.05), and after pairwise comparison, the differences were statistically significant (P<0.05). It was worth noting that the Wexner score of group C dropped significantly after treatment. The effective rate of treatment in group C was significantly higher that those in the other two groups. The result showed effective rate of group C (90%)＞ group B (80%)＞group A (53.5%), the difference was statistically significant (P<0.05). Conclusion Compared with the single treatment of rhubarb acupoint application or rectal finger force stimulation, the combined treatment had better efficacy, which reduced incidence of constipation and improved the quality of life of patients.

目的 探讨“分-全带教”在提高门诊实习生处方审核能力的应用效果。方法 对2016届实习生进行“分-全带教”,在实习初期、后期组织实习生对100张门诊处方进行处方审核,登记审核结果。结果 实施“分-全带教”后,处方成功审核例数实习初期的163例(27.17%)提高到后期的487例(81.17%)。结论 应用“分-全带教”模式,有利于门诊实习生掌握处方审核技巧,在提高实习生处方审核能力中有良好应用前景。

Objective To make a discussion of the application result of point-all teaching model in improvement of prescription review ability of interns at outpatient service process. Methods To implement point-all teaching model on interns enrolled in 2016. To ask them to review 100 outpatient prescription at the beginning and ending of the internship respectively and record the results of their review. Results After the implementation of point-all teaching model, the correct review of the prescription has been improved from 163 (27.17%) at the beginning to 487 (81.17%) at the ending. Conclusion The point-all teaching model is conducive for interns at outpatient department to master the technique for review, so it is promising in the improving the prescription review ability of interns.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

目的 探讨不同甲状腺结节手术治疗方案的合理性及临床效果。方法 选取本院2018年1月—2019年1月收治的120例患有甲状腺结节患者为研究对象,将其随机分为A组和B组各60例,A组患者未进行甲状腺细针抽吸细胞学检查直接进行甲状腺结节切除手术,B组患者接受超声负压引导甲状腺细针抽吸细胞学检查后给予手术治疗方案,比较两组患者手术前、后良恶性结节患者变化、术后复发率、并发症发生率及手术疗效。结果 术后A组残余恶性结节患者比例高于B组(P=0.001),A组健康无结节病变患者占比低于B组(P=0.002),A组患者恶性结节复发率高于B组患者(P<0.05);两组术后并发症发生率无差异(P>0.05),A组手术治疗总有效率低于B组(P<0.05)。结论 甲状腺结节患者术前有效超声穿刺诊断、术中超声引导手术及术后抗癌化疗治疗方案可以提高甲状腺结节患者手术有效率,B组方案具有重要临床推广价值。

Objective To investigate the rationality and clinical effect of different thyroid nodules surgical treatment. Methods A total of 120 patients with thyroid nodules admitted to our hospital from January 2018 to January 2019 were randomly divided into group A and group B, respectively. Group A patients did not undergo fine needle extraction. Aspiration cytology was performed directly for thyroid nodule resection. Group B patients underwent ultrasound negative pressure guided thyroid fine needle aspiration cytology and were given surgical treatment. The changes of benign and malignant nodules before and after surgery were compared between the two groups including postoperative recurrence rate, complication rate and surgical outcome. Results The proportion of patients with residual malignant nodules in group A was higher than that in group B (P=0.001). The proportion of patients with healthy no-nodular lesions in group A was lower than that in group B (P=0.002). The recurred rate of malignant nodules in group A was higher than that of group B (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The total effective rate of group A was lower than that of group B (P<0.05). Conclusion Preoperative effective ultrasound puncture diagnosis, intraoperative ultrasound guided surgery and postoperative anticancer chemotherapy treatment may improve the efficiency of thyroid nodules in patients with thyroid nodules. Group B has important clinical value.

目的 观察和评价重症毒蕈中毒(PMP)患者的临床资料,探讨血液灌流(HP)联合血液滤过(HF)与单独血液滤过治疗的疗效比较。方法 收集本院2016年8月—2018年10月救治的32例重症急性毒蕈中毒并发中毒性肝损伤、急性肾衰竭、中毒性心肌炎、消化道出血、中毒性脑病、急性血管内溶血等患者的临床资料,将32例患者分为治疗组和对照组,治疗组14例,采用持续静脉-静脉血液滤过24 h串联灌流2 h;对照组18例,采用单独血液滤过24 h,疗程2～3 d。两组患者内科常规治疗基本相同。结果 14例治疗组在内科常规治疗基础上联合血液灌流+血液滤过,好转率为92.9%(13/14);18例对照组在内科常规治疗基础上单用血液滤过,好转率为61.1%(11/18),两组好转率比较,差异有统计学意义(P<0.05)。治疗组患者黄疸、少尿、黑便、意识障碍等症状减轻,优于对照组;血清AST、ALT、TBil、DBil、PT、APTT水平较治疗前改善,优于对照组,差异有统计学意义(P均<0.05)。结论 毒蕈中毒患者常合并多脏器功能障碍(MODS),及早进行血液灌流联合血液滤过治疗较单独血液滤过能更有效的清除蛋白结合毒素和血清炎症因子,从而减轻内脏器官损害,改善肝、肾和凝血功能,治疗效果显著。

Objective To compare the clinical effect differences between hemoperfusion combined with hemofiltration with simple hemofiltration in treatment of severe mushroom poisoning patients. Methods 32 patients with toxic hepatitis,toxic myocarditis,toxic encephalopathy and acute renal failure due to poisonous mushroom were divided into two groups: treating group(n=14) and control group(n=18).Patients of treating group received continuous veno-venous hemofiltration for 24 hours combined with hemoperfusion for 2 hours.The cases of control group only received hemofiltration for 24 hours. Results After the treatment,the improvement rate in treating group were higher than that in control group(P<0.05).The disturbance of consciousness,jaundice,oliguria,melena in treating group were improved obviously and serum levels of AST、ALT、TBil、DBil、PT、APTT were reduced than those in controls(P<0.05). Conclusion Compared with simple hemofiltration,early hemoperfusion combined with hemofiltration for patients with severe toadstool poisoned can not only remove protein binding toxin and serum inflammatory factors,but also improve liver,kidney and coagulation function.

目的 分析广州血液中心以“生日献血纪念章”(下称生日纪念章)个性化专属纪念品对献血者的招募保留效果进行分析和研究。方法 2017年—2019年期间,广州血液中心生日当天献血者共11 790名,每半年生日当天献血的献血者人数,绘制折线图,分析2018年7月起“生日纪念章”活动前后,生日当天献血的献血者人数变化;卡方检验对比2组献血人群特征差异,分析该活动敏感人群。结果 2017年—2019年每半年生日当天献血人数总体持续增长,其中2018年7—12月较2018年1—6月,生日当天献血人数增长了406%,增长比例最大。活动前后2组人群性别、年龄、职业及既往献血次数分布差异均有统计学意义(P<0.05)。活动后男性、35岁及以上献血者、工人/职员及其他职业,固定献血者比例增加。结论 广州血液中心的“生日纪念章”活动对生日当天献血有明显的促进效果,其中,男性,年龄35岁及以上,工人/职业/其他职业及固定献血者对该活动更敏感,更可能选择生日当天献血。今后针对女性、25岁以下、学生及初次献血者,注意增加其他招募保留措施。

Objective To analyze the effect of the “Birthday Blood Donation Medal” (hereinafter referred to as the Birthday Medal) personalized souvenir to the blood donor recruitment and retention effect of blood donors in Guangzhou Blood Center. Methods From 2017 to 2019, there were a total of 11 790 blood donors donated blood on their birthday in Guangzhou Blood Center. Aline chart was drawn of the number of blood donors who donated blood on birthday to observe the trends every half a year from 2017 to 2019; Chi-square test was used to compare the characteristics of blood donors in two groups (before and after the “Birthday Blood Donation Medal” activity) and we analyzed the sensitive population of the activity. Results The number of blood donors on the birthday every half year from 2017 to 2019 continued to increase. Among them, the number of blood donors donated on birthday on July-December 2018 increased by 406% compared to the first six months of 2018, which was the largest increase. The differences in gender, age, occupation, and previous blood donation times between the two groups were statistically significant (P<0.05). After the activity, the percentage of male, 35-year-old and above blood donors, workers/clerks and other occupations, and regular blood donors increased. Conclusion The “Birthday Blood Donation Medal” activity in Guangzhou Blood Center has a significant promotion effect on blood donation on birthday. Among them, males, aged 35 and above, workers/occupations/other occupations and regular blood donors are more sensitive to this activity and are more likely to donate blood on birthday. In the future, other recruitment and retention measures should be taken to pay attention to women, under 25 years old, students and first-time blood donors.

目的 探讨凯格尔(Kegel)锻炼法结合生物反馈电刺激对产后盆底康复管理效果的影响。方法 选取2018年5月—2019年4月在我院妇产科阴道分娩的足月产妇200例,采用随机数字法分为对照组和观察组,每组各100例,对照组单纯给予Kegel锻炼法,观察组给予Kegel锻炼法结合生物反馈电刺激。干预2～3个月,比较两组患者盆底肌肉功能相关指标改善情况,并比较两组患者生活质量的改变。结果 干预后,观察组患者盆底肌Ⅰ类肌纤维肌力恢复正常率为86.0%(86/100),高于对照组的56.0%(56/100),观察组盆底肌Ⅱ类肌纤维肌力恢复正常率为83.0%(83/100),高于对照组的54.0%(54/100),差异均有统计学意义(P<0.05)。且干预后,观察组下腹不适、尿失禁、排尿异常、排便异常及阴道分泌物异常患者低于对照组(P<0.05),性生活质量评分高于对照组(P<0.05)。结论 Kegel锻炼结合生物反馈电刺激可促进盆底肌力,改善尿失禁、盆腔器官脱垂等盆底异常症状,提高患者生性生活质量。

Objective To explore the effect of Kegel exercise combined with biofeedback electric stimulation on the management of postpartum pelvic floor rehabilitation. Methods A total of 200 full-term pregnant women who delivered vaginally in our hospital from May 2018 to April 2019 were randomly divided into two groups: the control group and the observation group, with 100 cases in each group. The control group was only given Kegel exercise method, and the experimental group was given Kegel exercise method combined with biofeedback electrical stimulation. After 2～3 months of intervention, the improvement of pelvic floor muscle function and quality of life of the two groups were compared. Results After intervention, the recovery rate of pelvic floor muscle type I muscle strength in the observation group was 86.0% (86/100), higher than that in the control group (56/100), and the recovery rate of pelvic floor muscle type II muscle strength in the observation group was 83.0% (83/100), higher than that in the control group (54/100). The difference was statistically significant (P<0.05). After the intervention, the patients situations in the experimental group were lower than those in the control group (P<0.05) including abdominal discomfort, urinary incontinence, abnormal urination, abnormal defecation and abnormal vaginal secretion, and the score of sexual quality of life was higher than that in the control group (P<0.05). Conclusion Kegel exercise combined with biofeedback electrical stimulation may promote pelvic floor muscle strength, improve the symptoms of urinary incontinence, pelvic organ prolapse and other pelvic floor abnormalities, and improve the quality of life of patients.

目的 探究尿毒症继发性甲状旁腺功能亢进经甲状旁腺切除术治疗效果及安全性分析。方法 选取2017年6月—2019年5月于我院就诊的90例尿毒症继发性甲状旁腺功能亢进患者为研究对象,随机分为对照组与观察组,两组各45例。均采取同一药物治疗,对照组行次全切除治疗,观察组行甲状旁腺全切除术+前臂移植术。对比分析两组治疗效果、血生化指标及并发症。结果 观察组疗效优于对照组(P<0.05);观察组术后1周、1个月钙、iPTH、磷、钙磷乘积及ALP水平均低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论 甲状旁腺全切除+前臂移植治疗尿毒症继发性甲状旁腺功能亢进疗效显著,并发症风险低,值得推广。

目的 观察实施微信式延续护理干预对真菌性外耳道炎患者心理状态及治疗效果的影响。方法 选取我院2018 年12月—2019年12 月期间门诊治疗的110例真菌性外耳道炎患者为观察对象,将所选患者随机分为常规组和干预组,常规组55例,采取常规护理;干预组55例,在常规护理的基础上实施微信式延续护理干预。观察两组患者的心理状态及治疗依从性、治疗效果的变化。结果 干预组患者心理状态的改善、治疗依从性、治疗效果均优于常规组,差异有统计学意义(P＜0.05)。结论 在给予真菌性外耳道炎患者实施护理干预的过程中,加入微信式延续护理干预,患者的心理状态得到改善、治疗依从率增加及患者治疗的总有效率提高。因此微信式延续护理干预值得在临床护理中进一步推广。

Objective To observe WeChat continuous nursing intervention on mental state and therapeutic efficacy of fungal external auditory meatus. Methods 110 cases of fungal external auditory meatus treated in our hospital from December 2018 to December 2019 were selected as the observation objects,The selected patients were randomly divided into the conventional group and the intervention group,There were 55 cases in the conventional group,taking regular care; there were 55 cases in the intervention group,on the basis of routine nursing,WeChat continuous nursing intervention was implemented. The psychological status and treatment compliance of the two groups were observed,also changes in treatment outcomes. Results The improvement of psychological state,treatment compliance and treatment effect in the intervention group were better than that in the conventional group.The difference was statistically significant(P＜0.05). Conclusion In the course of nursing intervention for patients with fungal external auditory meatus,WeChat continuous nursing intervention was added.The psychological state of the patients has been improved,the rate of treatment compliance is increased and the total effective rate of treatment is increased greatly.Therefore,WeChat continuous nursing intervention is worthy of further promotion in clinical nursing.